ED Toolkit for Opioid Use Disorder

The goal of the META:PHI ED Toolkit for Opioid Use Disorder is to provide the resources necessary for a prescriber in any emergency department in Ontario to initiate buprenorphine when appropriate, along with additional materials to support all ED staff in providing evidence-based care for patients with opioid use disorder.

This toolkit was inspired by the CA Bridge External link icon program.

Prescriber information

Approach to Patients With Opioid Use Disorder in the ED: Buprenorphine Standard Initiation

This flowchart provides an algorithm for a standard buprenorphine (Suboxone) initiation in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 7 February 2024

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High-Dose Buprenorphine Initiation (“Macrodosing”) for ED Providers

A short guide to high-dose buprenorphine (Suboxone) initiation (macrodosing) in the emergency department.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Buprenorphine Macrodosing Initiation

A decision-making tool for high-dose buprenorphine (Suboxone) initiation (macrodosing) in the emergency department.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Buprenorphine/Naloxone (Suboxone®): Reference Guide for ED Providers

A guide for emergency department (ED) clinicians about initiating buprenorphine (Suboxone) in the ED.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Buprenorphine FAQs

Responses to some frequently asked questions about initiating buprenorphine (Suboxone) in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 7 February 2024

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Buprenorphine/Naloxone (Suboxone®): Information for Community Providers

A short guide for community providers on prescribing buprenorphine (Suboxone) to patients with opioid use disorder (OUD).
Part of ED toolkit for OUD
Version date: 7 February 2024

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Starting Methadone in the ED

A decision-making tool for initiating methadone in the emergency department.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Templates

Methadone Inititiation Order Set

An order set for emergency department initiation of methadone.
Part of ED toolkit for OUD
Version date: 7 February 2024

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ED Methadone Prescription

A template for an outpatient methadone prescription after emergency department discharge.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Substance Use Screening Questions

A checklist for emergency department (ED) clinicians when asking a patient about their substance use.
Part of ED toolkit for OUD
Version date: 12 January 2022

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Opioid Withdrawal/Buprenorphine Initiation Order Set

An order set for emergency department (ED) buprenorphine (Suboxone) initiation, both standard and macrodosing.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Clinical Opioid Withdrawal Scale (COWS)

The Clinical Opioid Withdrawal Scale (COWS) is a validated scale for measuring opioid withdrawal severity.
Part of ED toolkit for OUD
Part of RAAM clinic toolkit
Version date: 19 September 2022

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Buprenorphine Prescription after ED Initiation

A template for an outpatient prescription for buprenorphine (Suboxone) after initiation in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 7 February 2024

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Home Start Buprenorphine Prescription

A prescription template for home initiation of buprenorphine (Suboxone) after emergency department (ED) discharge.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Microdosing Buprenorphine Prescription

A prescription template for home microdosing initiation of buprenorphine (Suboxone) after emergency department (ED) discharge.
Part of ED toolkit for OUD
Version date: 7 February 2024

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ED Discharge Referral to RAAM

A RAAM clinic referral template for patients being discharged from the emergency department (ED).
Part of ED toolkit for OUD
Version date: 7 February 2024

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Administrative resources

Pharmacy & Therapeutics Committee: Request for Addition of Buprenorphine/Naloxone to Drug Formulary

A sample application form to add buprenorphine (Suboxone) to the emergency department (ED) formulary.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Naloxone Kit Distribution: Policy

Sample policies and procedures for providing take-home naloxone kits to emergency department (ED) patients who are at risk of opioid overdose.
Part of ED toolkit for OUD
Version date: 1 April 2021

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Naloxone Kit Distribution: Emergency Department Medical Directive

A sample medical directive authorizing emergency department (ED) staff to provide take-home naloxone to patients at risk of opioid overdose.
Part of ED toolkit for OUD
Version date: 1 April 2021

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ED Naloxone Kit Distribution Record

Part of ED toolkit for OUD
Version date: 1 April 2021

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Addressing Stigma

Information for emergency department (ED) staff on how language, behaviour, and attitudes can convey stigma towards people who use drugs.
Part of ED toolkit for OUD
Version date: 1 April 2021

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Patient materials

Suboxone Treatment: What to Know and Expect

A patient handout about buprenorphine (Suboxone) treatment.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Starting Suboxone (Buprenorphine) with Microdosing

A patient handout about microdosing buprenorphine (Suboxone) initiation.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Starting Suboxone (Buprenorphine) at Home

A patient handout for starting buprenorphine (Suboxone) at home.
Part of ED toolkit for OUD
Version date: 7 February 2024

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Naloxone Kit Insert: Responding to an Overdose in a Toxic Drug Supply

Instructions on naloxone use for printing and inserting in take-home naloxone kits. Created by CATIE.
Part of ED toolkit for OUD
Version date: 1 April 2022

Link

Jennifer Wyman MD FCFP DABAM MPH
Larry Nijmeh MD CCFP (EM) FCFP
Elizabeth Shouldice MD MPH CCFP (EM) FCFP

Ruben Hummelen MD CCFP
Meldon Kahan MD CCFP FRCPC
Michelle Klaiman MD FRCPC DABAM
Helen Manohararaj MScN NP-PHC ENC (C)
Lisa Roth MD CCFP
Amit Shah MD CCFP (EM) FCFP
Anita Srivastava MD MSc CCFP

James Brokenshire MD CCFP (EM)
Calvin Chan MD CCFP
Katie Dunham BSc Hons BScN MN NP-PHC
Jonathan Gravel MD CCFP (EM)
Nour Khatib MD CCFP (EM)
Kate Lazier MD CCFP (EM) FCFP
James McGorman MD CCFP (EM)
Hasan Sheikh MD CCFP (EM)
Max Zworth MD PGY-1 (EM)